The role of diuretics in the management of hemodialysis patients has not been clearly defined.
An observational study by Bragg-Gresham et al [65] suggested there may be a survival advantage to diuretic use in hemodialysis patients with little to no residual renal function. Patients on continuous ambulatory peritoneal dialysis (CAPD) are dependent on residual renal function for solute and water clearances, and this declines with time on dialysis. In a prospective, randomized, open-label study, Medcalf et al [66] showed that furosemide given at 250 mg per day produced a clini- cally significant preservation in urine volume over 1 year of CAPD. This was associated with a possible improvement in fluid balance and no increase in side effects but did not have effect on preserving residual renal function.